| NPI | 1881949295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071.009471) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE OOOO) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 7201) | |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2022-04-18 |